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CITY MARKET PHARMACY #404
SCH060071-00 DELTA COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DELTA COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH060071-00
Entity Address
1501 E. 3RD ST.
DELTA, CO 81416
Medicare Provider Number
060071
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
CITY MARKET PHARMACY #404
Pharmacy Address
PHARMACY DEPARTMENT
122 GUNNISON RIVER DRIVE
DELTA, CO 81416
Pharmacy Comments
Contract Details
Approval Date
8/25/2022
Contract Begin Date
8/29/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Matthew Heyn, CEO
(970) 874-2229
Contract Pharmacy Representative
Kroger
Katie Elfers, 340B Pharmacy Administrator
(513) 762-4850
Signed By Date
8/25/2022
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